Then , using the AMA ’ s Physician Masterfile of all U . S . doctors ( not just AMA members ), Dr . Sinsky et al ., estimated the cost to Medicare of losing one ’ s personal doctor . They assigned an average panel of 1,000 patients to each doctor and used published Medicare data for costs . They had to calculate cost estimates for patients not on Medicare . Increased costs arise when the New Doc does not know the patient : more ER visits result , more specialists are consulted , more labs and tests are ordered , and more frequent visits to coordinate and understand all these variables are necessary .
They found that turnover in one ’ s PCP cost the U . S . at least $ 979 million extra yearly , with just under a third ($ 260 million ) attributable to loss of one ’ s doctor due to burnout .
A doctor who knows patients well has a different comfort level with uncertainty , watchful waiting , and hope that therapeutic measures will take hold . A doctor newly confronted with an elderly man who lives alone , eats poorly and has lost weight is far more anxious about proving no malignancy exists than his old doc , who ’ d watched his weight change the same three pounds since his wife died .
Screenings get missed with changeover - the new doc can ’ t yet inspire the same desire to Do Things Right that the old one could - plus loss of records . Patients lose heart at having to break someone in ,
DOCTORS ' LOUNGE and simply disappear , restarting the whole cycle . The repeat EGDs , CTs and stress tests for various kinds of chest pain add up rapidly as docs struggle to make sense of multiple complaints .
If we all want to have actual doctors - if young ones stay and work instead of leave - taking care of them is paramount . And don ’ t talk to me about resilience . Make sure their minute-to minute - because in an office with 15-minute appointments , that ’ s how you live - personal assistant is competent : nice to people , learns when sick matters , and gets details right the first time . They fill things out , they think then do the next step , and they holler when the patient doesn ’ t sound right on the phone .
Pay such people more : that would help keep them . After all , it costs the country nearly a billion dollars more a year just for patients whose docs disappear . Paying those doctors ’ assistants better , training them better , could help slow that progression .
Every doc has got to have someone who has their back , all day long . Without one , practice is untenable : exit stage left .
Dr . Barry is an internist and Associate Professor of Medicine ( Gratis Faculty ) at the University of Louisville School of Medicine , currently retired and mulling her next moves .
CORRECTION from VOL . 69 NO . 9 | FEBRUARY 2022 : Dr . Polk ' s first horse was named DAGGER Counter not Geiger Counter - my error - Dr . Barry
A
friend forwarded me an article recently , a day before it became headline news , about Rev . Andres Arango , a priest of the Diocese of Phoenix , who resigned after it was determined that he performed the sacrament of baptism incorrectly for decades . The slight of his task boiled down to the use of one word , “ we ”, instead of “ I ”, in the culminating phrase “ I baptize you in the Name of the Father and of the Son and of the Holy Spirit .” According to the Diocese of Phoenix website , all of the baptisms he performed “ until June 17 , 2021 , are presumed invalid ” and “ therefore invalidates any subsequent sacraments .”
Dear Jesus , please tell me there is more to the story than we instead of I . Please , dear Lord . In the name of the Father , Son , and Holy Spirit , Amen .
Apparently , this diocesan predicament had occurred previously , but , thankfully , the news had missed the frames of my Warby
OH , HELL NO AUTHOR John David Kolter , MD
Parkers . Fortuitously , for the Diocese of Phoenix , it was able to pass the buck to the wisdom of The Congregation for the Doctrine of the Faith ( CDF ) who , in 2020 , addressed the issue of the validity of baptisms in this very situation . They “ authoritatively ” ruled that using the word “ we ” does not convey the sacrament of baptism and that ministers must allow Jesus to speak through them and say , “ I .” Allowing Jesus to speak through oneself is no small task and creates a clear power dynamic with those to whom one speaks . Yet , in declaring the ability to giveth and then taketh away what is not theirs to take , the clerical leadership of the church well risk alienating their parishioners . Having dealt with our own god complex , medicine has traversed an arc of shifting power dynamics in the last half century , now bearing little resemblance to the field of the past . Clerical leadership may wish to learn from our experience and follow a more inclusive arc .
The responsibility placed upon clerics is evident and may seem quite tedious under examination of the current situation in Phoenix . Physicians can relate . Both professions carry responsibility embedded into a power dynamic that favors the practitioner . Certainly ( continued on page 32 )
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